ECT in the Presence of Hypertrophic Cardiomyopathy: New Case Report From Germany

Out on PubMed, from clinicians in Germany, is this case report: 

Electroconvulsive therapy in a patient with hypertrophic cardiomyopathy: A case report.

Kufner M, Nothdurfter C, Steffling D, Baessler A, Maier LS, Qamar Y.Clin Case Rep. 2022 Sep 5;10(9):e6286. doi: 10.1002/ccr3.6286. eCollection 2022 Sep.PMID: 36093461 
The abstract is copied below:

The use of electroconvulsive therapy (ECT) in patients with underlying cardiac disease like hypertrophic cardiomyopathy (HCM) remains without satisfactory clinical guidelines. We provide a case report of successful application of ECT in a 43-year-old patient with bipolar disorder and comorbid HCM, including detailed diagnostic information and outlining key clinical considerations.

Keywords: bipolar disorder; case report; electroconvulsive therapy; hypertrophic cardiomyopathy; major depressive disorder.

The report is here.
And from the text:

All's well that ends well, but I have a few issues with this case report. First, it features a John Read reference. Second, if they were really so concerned about cardiovascular/anesthesia risk (a situation in which you want to minimize the number of anesthesia exposures) why would they not use bilateral electrode placement and taper the course to prevent relapse? Maybe the risk wasn't really that great? Maybe  they got the complicated medical stuff right, but the basics not so much?
All's well that ends well, and I am glad these authors have contributed to the literature about the safety of ECT in the presence of this form of cardiac disease.





Comments

  1. ECT BloggerOctober 11, 2022 at 6:31 AM

    The below comment is from Dr. Max Fink:

    The Surprising Safety of Seizures

    Are we not surprised by the safety of inducing grand mal seizures in humans with cardiac, systemic, and brain diseases? The seizure is a patterned bodily motor response that stresses the whole body that remarkably does not lead to death. Indeed, the death rate for ECT is lower than many surgical procedures. So, what is a seizure, that affects the brain and bodily motor system but does no kill?

    A seizure is an inherent reflex of mammals that occurs in response to abnormal stresses. The major changes in the brain and body are the release of brain hormones that are essential in systemic defenses of the body.

    So, how do seizures change brain functions that are associated with severe depression, catatonia, delirium and mania? What is the basis for the success of induced seizures in relieving serious brain dysfunctions?

    Following Bernard Carroll's demonstration of the connections between the HPA axis and melancholia and its relief by induced seizures, a broad hypothesis of the seizure releasing the HPA and HPT hormones, described by Ottosson and Fink in 1980. A theory of convulsive therapy in endogenous depression: Significance of hypothalamic functions. Psychiatry Research 2: 49-61.

    The success and safety of ECT in patients with severe systemic diseases warrants more attention to mechanisms.

    Max Fink

    ReplyDelete

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